We know not the hour..................
The recent insightful blog by Lies Scaut and Erik de Soir in
the Crisis Response Journal (1) on dealing with bereavement in the current pandemic
brought together elements of best practice in a difficult subject area. The news story run by the BBC on the increase
in will writing in the last few weeks (2) , coupled with the images of mass
pauper burials in New York (3) have all reinforced a key point about dealing
with this international emergency. We
all talk about the need to save lives but at the same time we know that
thousands of people are dying earlier than they would have had not Covid-19
appeared.
The sub text of every news story is about
death and the fear of death, both personally and the potential death of those
we love.
We don’t talk about death very much in the UK (although the
subject is not quite so taboo in Ireland and Scotland). We like to think of it as something that
happens to other people. Except for
specialist professions most of us have very little contact with the physical
reality of death. Gone are the days of
the deceased lying in the front parlour at home and, unlike some continental
countries, open coffin funerals are almost unheard of. We have become distanced from the one event
that will overtake all of us. One often
hears the phrase ‘if I die’. It is not
polite to point out that it is always a question of not if but when. The pandemic has stripped away the protective
mechanisms that have allowed us to be ‘socially distanced’ from death. In doing so what normally happens behind the
scenes is now subject to media and public scrutiny. There is now no dodging the question about
what to do with the dead.
Around 600,000 people die each year in the UK. More people die in the winter than in the
summer. The funeral industry has
developed to deal with this volume and with seasonal fluctuations. Any sudden change requires a change in
approach. Most undertakers are parts of
large chains and can, to a limited extent, use their size to manage changes in
demand. But of course the management of
the dead involves not just undertakers.
In the Summary of Impacts produced for the Coronavirus Bill (as
it then was) the authors spoke of the ‘death management industry’ (4) Within this description is included
cemeteries and crematoria. The note makes
it clear:
“To ensure we can respond effectively to this demand on
the death management sector, Local Authorities may have to direct a fragmented
sector and current legislation does not allow this”
To achieve this very wide ranging powers of direction are
included in the Act for the potential use of government and local authorities . These provisions include the creation of
offences.(5).
The Act takes several other powers relating to the
management of the dead including the ability to make changes to the
arrangements for jury inquests and death registration. Of interest is the provision that removes the
requirement for a second doctor to confirm the cause of death before
cremations. All this is an example of
true emergency planning working in the background and contemplating the unthinkable. In other words thinking about what the public
don’t want to confront.
The images of the mass burials in New York are very much a
product of the local situation and culture.
In the UK burials of the those too poor to afford a funeral generally
take place in publicly owned cemeteries rather than in what appears to be a
pauper, (not a word that one uses frequently in the 21st century),
burial island. All countries have
experience of mass burial but in the UK this is rare. In the aftermath of the 9/11 attacks I worked
in what became the London Resilience Team. We looked at these issues then. I
learnt a lot very quickly. Burial places
are not just holes in the ground. They
are properly surveyed and maintained locations that have facilities for
memorials. They are engineered to
prevent flooding. They are, ironically
as it seems, attractive places that facilitate respectful memory. I remember one expert at the time pointing out
that even during the plagues of 17th century mass burials were the exception. As Scaut and de Soir point out societies cling
hold of their norms and traditions around death. Gladstone is supposed to have said:
““Show me the manner in which a nation cares for its dead
and I will measure with mathematical exactness the tender mercies of its
people, their respect for the laws of the land, and their loyalty to high
ideals.” (6)
This was a theme of the Non Statutory Inquiry by Lord
Justice Clarke Inquiry into the identification of the deceased after major transport
accidents and which forms the basis of much of our practice in disasters (7). Burial space in the UK is in short supply but
this pandemic will not cause an immediate shortage. The pressure points come in the period leading
up to the disposal of dead.
For some years the government has tried to retreat from
having responsibility for national mortuary arrangements. Despite this the plans for emergency mortuary
provision have improved dramatically in the last 20 years. The experience of managing the return of the
dead after the Tsunami and the most impressive work done to establish and
operate a disaster mortuary after the 7/7 attacks are important sources of
experience. Mortuaries are places of
process. Bodies are examined. They are identified and, when necessary, they
are the venue for full post mortem examinations. Such activities need space, equipment and
specialised, highly trained staff. If
there is a ‘lucky’ side to a pandemic it is that most of these provisions are
not required. The deceased in a
terrorist attack or a downed aeroplane require painstaking attention. Many of the bodies will be disrupted. In the current situation whole bodies with a
known course of death present the authorities with the logistical challenge of
storage and integrity of identification.
The issue is one of appropriate storage and the adaptation of
processes. The authorities need to buy
time to allow the funeral sector to catch up and for families to be safe in the
knowledge that their loved ones have been handled respectfully and in
accordance with their faiths – as far as the current restrictions allow. Public Health England (PHE) has published practical
advice and guidance on handling the dead (8) and we should congratulate
emergency planners, (a group much reduced in times of austerity), for rising to
the task of putting into practice plans that were often regarded as fantasy
projects by those in charge.
The pandemic has moved into an emotionally different phase. We are at the stage when many people know, or
at least know of, someone who has died with the virus. The population are being required to confront
their mortality and that of those they know and love. Perhaps one of the changes that may emerge in
the post pandemic UK is a greater willingness to confront, and to some extent
to be comfortable with, the inevitability of death. Perhaps we will allow the subject to be
discussed without someone telling us that we are ‘being morbid’. Every adult should have a will. Every adult should have discussed with their
loved ones what they would like to happen at the end of their lives. Death should not be a taboo. It is a fact of life.
(5)
S58 and Sch 28 Coronavirus Act 2020 (c.7).
London. TSO. http://www.legislation.gov.uk/ukpga/2020/7/contents/enacted
(6)
Although the source is more likely to be an
advertising campaign for the funeral industry: https://en.wikiquote.org/wiki/William_Ewart_Gladstone
(7)
The Report of the Public Inquiry into the
Identification of Victims Following Major Transport Accidents Lord Justice
Clarke. (Cm 5012) https://webarchive.nationalarchives.gov.uk/nobanner/20141104114956/http://assets.dft.gov.uk/marchioness-nsi.org.uk/index.htm
All web references checked 11th
April 2020.
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